Ventricular mass and diastolic function in patients infected by the human immunodeficiency virus

Abstract

Objective-Echocardiographic and Doppler analysis of myocardial mass and diastolic function in patients infected with HIV. Design-Case-control study. Setting-Tertiary referral centre, Huelva, Spain. Patients-61 asymptomatic patients with HIV infection and 32 healthy controls. Main outcome measures-Time motion, cross sectional, and Doppler echocardiographic studies were performed, and left ventricular mass and diastolic function variables determined (peak velocity of early and late mitral outflow and isovolumic relaxation time). Results-Left ventricular mass index (LVMI) was decreased in patients compared with healthy controls (mean (SD): 76.7 (23.6) v 118.8 (23.5) g/m 2 , p < 0.001). Linear regression analysis showed a correlation between LVMI and brachial fat and muscle areas. The ratio of peak velocities of early and late mitral outflow was decreased in HIV infected patients compared with controls (1.19 (0.44) v 1.58 (0.38), p < 0.001). This ratio was exclusively related to haemodynamic variables (heart rate, systolic and diastolic blood pressures). HIV infected patients had a prolonged isovolumic relaxation time (103.0 (10.5) v 72.9 (12.9) ms, p < 0.001). Isovolumic relaxation time was correlated only with brachial muscle area on multivariate analysis. Conclusions-HIV infected patients had a reduced left ventricular mass index and diastolic functional abnormalities. These cardiac abnormalities are predominantly related to nutritional status. (Heart 2000;84:620-624)

Left ventricular remodelling in asymptomatic HIV infection on chronic HAART: comparison between hypertensive and normotensive subjects with and without HIV infection

“…[17][18][19][20][21][22][23][24] In fact, taken together these studies obtained dissimilar results: if preclinical diastolic dysfunction is often reported, LV mass has been found increased, normal or even reduced and LV systolic function normal or, in few studies, impaired. 38 Actually, these studies can hardly be compared with each other and with our study, mainly because of great differences in such relevant issues as methods employed (that is, clinic BP values, absolute values of LV mass instead of values indexed for body surface area or height ) and patients characteristics (asymptomatic HIV þ patients, HIV þ patients with various degrees of malnutrition, AIDS patients, mixed groups of asymptomatic and symptomatic HIV þ patients, only women, only African or African-American subjects).…”

“…Previous studies [17][18][19][20][21][22][23][24] on LV characteristics in HIV þ patients reached dissimilar results, probably because of great differences in study design, methods and patients characteristics.…”

“…Moreover in some studies HIV þ patients and controls were significantly different with regard to smoking habit, BMI and/or BP values; often no information was available about BP profile or antihypertensive and antidyslipidemic treatment. [17][18][19][20][21][22][23][24] It is beyond the scope of this cross-sectional study to deal with the pathophysiologic mechanisms linking HIV infection and chronic HAART to LV remodelling. However, we can hypothesized that, besides other mechanisms like myocardial viral infection, direct myocardial mitochondrial toxicity by antiviral drugs and chronic inflammation, a relevant role could be played by metabolic complications.…”

Echocardiographic Abnormalities and Associated Factors in a Cohort of Asymptomatic HIV-Infected Patients

“…Various different theories have been developed involving the HIV infection itself, inflammatory factors, ART, 4 and classic cardiovascular risk factors that are heightened by the presence of the other factors. 5 In the specific case of LV hypertrophy the data are contradictory, with some authors defending a lower ventricular mass in HIV-infected patients 6 whereas others suggest the opposite. 7,8 LV hypertrophy and LV diastolic dysfunction are related to the development of heart failure in asymptomatic patients and have an important impact on morbidity and mortality in the general population.…”

“…6 LV hypertrophy in the general population is related to age, hypertension, and certain inflammatory states. The only factor in our study associated with this echocardiographic finding was diabetes mellitus.…”